Respiratory insufficiency in newborns with abdominal wall defects

Marc B. Hershenson; Robert T. Brouillette; Linda Klemka; John D. Raffensperger; Andrew K. Poznanski; Carl E. Hunt

doi:10.1016/S0022-3468(85)80217-7

Respiratory insufficiency in newborns with abdominal wall defects

Marc B. Hershenson, Robert T. Brouillette^*, Linda Klemka, John D. Raffensperger, Andrew K. Poznanski, Carl E. Hunt

^*Corresponding author for this work

Radiology

Research output: Contribution to journal › Article › peer-review

82 Scopus citations

Abstract

Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.

Original language	English (US)
Pages (from-to)	348-353
Number of pages	6
Journal	Journal of pediatric surgery
Volume	20
Issue number	4
DOIs	https://doi.org/10.1016/S0022-3468(85)80217-7
State	Published - Aug 1985

Funding

From the Departments of Pediatrics, Radiology, and Surgery Northwestern University, Chicago. Supported in part by a grant from the Children's Research Guild. Presented in part at the Annual Meeting of the Midwest Society for Pediatric Research, Chicago, November 2-4, 1983; and at the 33rd Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Chicago; September 15-16, 1984. Address reprint requests to Robert T. Brouillette, MD, Division of Neonatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9 1985 by Grune & Stratton, Inc. 0022-3468/85/2004~)011 $03.00/0

Keywords

Omphalocele
abdominal wall defect
gastroschisis
respiratory failure

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

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10.1016/S0022-3468(85)80217-7

Cite this

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title = "Respiratory insufficiency in newborns with abdominal wall defects",

abstract = "Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.",

keywords = "Omphalocele, abdominal wall defect, gastroschisis, respiratory failure",

author = "Hershenson, {Marc B.} and Brouillette, {Robert T.} and Linda Klemka and Raffensperger, {John D.} and Poznanski, {Andrew K.} and Hunt, {Carl E.}",

note = "Funding Information: From the Departments of Pediatrics, Radiology, and Surgery Northwestern University, Chicago. Supported in part by a grant from the Children's Research Guild. Presented in part at the Annual Meeting of the Midwest Society for Pediatric Research, Chicago, November 2-4, 1983; and at the 33rd Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Chicago; September 15-16, 1984. Address reprint requests to Robert T. Brouillette, MD, Division of Neonatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9 1985 by Grune & Stratton, Inc. 0022-3468/85/2004~)011 $03.00/0",

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AU - Poznanski, Andrew K.

AU - Hunt, Carl E.

N1 - Funding Information: From the Departments of Pediatrics, Radiology, and Surgery Northwestern University, Chicago. Supported in part by a grant from the Children's Research Guild. Presented in part at the Annual Meeting of the Midwest Society for Pediatric Research, Chicago, November 2-4, 1983; and at the 33rd Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Chicago; September 15-16, 1984. Address reprint requests to Robert T. Brouillette, MD, Division of Neonatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. 9 1985 by Grune & Stratton, Inc. 0022-3468/85/2004~)011 $03.00/0

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N2 - Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.

AB - Respiratory failure in newborns with abdominal wall defects has been attributed to increased intra-abdominal pressure and elevation of the diaphragm after closure. Despite surgical techniques designed to minimize intraabdominal pressure, we have obseved prolonged respiratory insufficiency in several such infants. We reviewed the charts of 108 infants from 1975 to 1982 who had abdominal wall defects: 53 with gastroschisis, 29 with small omphaloceles, 22 with liver-containing or giant omphaloceles (GO), and four with cloacal exstrophy. Nine infants with GO (41%) had prolonged respiratory insufficiency and five died. Infants with GO required longer periods of oxygenation and ventilation (P<.001, ANOVA) than infants with other abdominal wall defects. Clinical observation suggested that infants with GO have a small, narrow thorax. We obtained detailed measurements from the chest radiographs of infants in all groups. After correction for birth weight, babies with GO had smaller chest widths (P<.001) and lung areas (P<.05) than infants with other abdominal wall defects. At autopsy, one newborn with GO was found to have severe pulmonary hypoplasia. Prolonged respiratory insufficiency in infants with GO may be explained by pulmonary hypoplasia and/or by a narrow chest deformity which limits lung expansion.

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ER -

Respiratory insufficiency in newborns with abdominal wall defects

Abstract

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Keywords

ASJC Scopus subject areas

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